Disorders of the Spine

Back and neck pain

Back pain is the leading cause of disability worldwide. It is one of the most common reasons people visit their family doctors.

Most cases of back pain are acute and caused by muscle and ligament strain. The majority of people recover from these episodes within two weeks with over-the-counter pain relievers and modified activity.

Back pain is classified as persistent when it is resistant to simple treatment and lasts longer than two to four weeks. When this happens, further medical evaluation is needed. Your physician will perform a detailed review of your medical history as well as a thorough physical examination.

The most common causes are strains of the muscles and ligaments of the back, disk herniation, osteoarthritis of the joints in your back or neck (facet joints) and spinal stenosis.

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Strains and sprains

A strain is an injury to a muscle or tendon that occurs when it is twisted, pulled, or torn. A sprain is a stretching or tearing of a ligament that connects two or more bones at a joint.

These injuries can occur from overuse after prolonged, repetitive movement, or after a fall or sudden twisting movement.

Treatment usually involves pain relievers/anti-inflammatory medications, muscle relaxants, physical therapy, and ligament or trigger point injections.

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Disk herniation

A herniated disk is a rupture or extrusion of disk material (nucleus pulposus) from the rubbery cushions that sit between the bones in the back. When this happens, direct pressure and inflammatory mediators (the messengers that contribute to the inflammatory response of blood vessels and cells) irritate the nearby spinal nerve roots, causing pain that is often described as tingling, burning or electrical. This can cause severe leg — commonly known as sciatica—or arm pain and may cause nerve damage if not treated properly.

Disk herniation is most often the result of age-related changes, but it can be related to lifting heavy objects or physical trauma.

Risk factors for herniated disks include excess body weight, smoking, physically demanding jobs or repetitive lifting, pushing, pulling, twisting or bending.

Treatment includes over-the-counter pain medications, physical therapy, epidural steroid injections, spinal cord stimulation or surgery.

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Spinal stenosis

Spinal stenosis is a narrowing of the spinal canal. It can occur alone or in conjunction with disk herniation. It is most frequently caused by degenerative changes, which include thickening of the ligamentum flavum, facet joint enlargement or osteophytes (bony outgrowths), or it can be congenital in nature.

This narrowed spinal canal causes compression of the spinal cord, which can lead to numbness or tingling in a foot or arm, weakness in an arm or leg, or pain or cramping in your legs when standing for long periods of time or when walking. Spinal stenosis in your neck can also be associated with problems with walking and balance, or with bowel or bladder dysfunction.

Treatment involves interlaminar epidural steroid injection, transforaminal epidural steroid injection, minimally invasive lumbar decompression, placement of a spinal spacer or surgery.

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Spondylosis (degenerative arthritis of the spine)

Spondylosis, also known as degenerative arthritis of the spine, is age-related changes of the bones and disks of the spine. These changes affect the facet joints in the back and lead to pain. Symptoms often include back or neck pain during or after movement, stiffness after waking in the morning or with inactivity, tenderness to touch over the bones in your neck and back, feeling a grating sensation, or hearing popping or cracking.

Facet joints are pairs of small joints that are situated at each vertebral level of the spine. Each facet joint is connected to two medial nerves that carry pain signals from the spine to the brain. As these joints degenerate, those nerves continuously transmit pain signals to the brain.

Risk factors for arthritis include older age, being female, excess body weight, physical trauma and repeated stress on the neck and back.

Treatment involves facet medial branch blocks and medial branch radiofrequency ablation.

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Failed back surgery syndrome

Failed back surgery syndrome refers to a group of patients who have new or persistent pain after spinal surgery for back or leg pain. The term does not indicate there was a problem during the surgery or that it was performed incorrectly, just that pain continued.

The pain can be related to degeneration above or below the surgery site, damage that occurred to the nerve prior to surgery that did not heal, or the formation of scar tissue around the nerves.

Treatment involves physical therapy, epidural steroid injections, medial branch blocks and spinal cord stimulation.

Vertebral compression fractures of the thoracic and lumbar spine

Vertebral compression fractures occur when the disease known as osteoporosis weakens bones of the spinal column, known as vertebral bodies.

In these and similar conditions, the bone in the spinal column becomes weaker, allowing vertebral bodies to fracture as they attempt to support the body. These fractures can be quite painful and can cause the spinal column to become shorter and lean forward. Vertebral compression fractures are commonly diagnosed with X-rays, CT or MRI scans.

Conservative options for treatment, including rest, bracing and pain medication, are used when physicians believe the fracture may heal on its own with time. When pain is severe and debilitating and the fracture is still in its early stages, vertebral augmentation — a procedure known as kyphoplasty — can improve severe and acute pain. This procedure involves the injection of cement into the fractured vertebral body to help stabilize the bone and reduce pain.

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The links to the videos on this page are for informational purposes only. The video content is not intended to be professional medical advice, diagnosis or treatment or as a substitute for professional medical advice, diagnosis or treatment. The links will take you to Veritas Health content. Veritas Health publishes educational health information to help patients better understand symptoms, conditions, and a variety of treatment options. Their content is authored by expert health professionals but does not reflect the opinions of UK HealthCare or our providers. Always seek the advice of your physician or other qualified health professional with any questions you may have regarding your health. Reliance on the content is solely at your own risk.